Acupuncture and dry-needling for low back pain (Review)

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Feedback 2: Which acupoints were used? What were the classical symptoms of pain being modified? My understanding is that whilst acupuncture modifies pain, in doing so the manifestations of pain are being treated. In the outcome of the study you mention function as one of those outcomes. What were the functional factors and how were they measured? I am interested in the inclusion and exclusion criteria for participants in the study, were there any controls, that is, participants without low back pain? Reply Response 1: The outcomes were assessed immediately after the end of treatment, and at short, intermediate and long-term follow-ups. Definitions of these time-lines are given in the review. The outcomes of interest were patient-reported pain and function. The authors of the systematic review did not include neurological outcomes and neither did the trials. We don’t know if data were collected on these items in the original studies and not included in the published reports. Response 2: I think some of the details you are looking for can be found in the ’Table of Included Studies’. If they are not listed, its because they were not included in the published report of the primary study, but to be sure, you may wish to refer to some of the primary studies if you had particular questions. The full text outlines which studies were included in these comparisons: [i] Acupuncture compared to no treatment, placebo or sham therapy [ii] Acupuncture compared to another intervention [iii] Acupuncture added to an intervention compared to the intervention without acupuncture. The authors also outline other outcomes and comparisons in the results section. The inclusion criteria only included Individuals with back pain. Different aspects of pain and the tool used to measure them would have been addressed in different studies ... this will be in the Table of Included Studies; ditto for functional outcomes and measurement tools and participants of each study. Contributors Dr Henare R Broughton, Occupation Family Physician Dr Andrea Furlan, review author W H A T ’ S N E W Last assessed as up-to-date: 1 June 2003. Date Event Description 19 January 2011 Amended Contact details updated. H I S T O R Y Protocol first published: Issue 2, 1998 Review first published: Issue 1, 1999 Date Event Description 14 July 2010 Amended contact details amended 29 May 2008 Amended Converted to new review format. Acupuncture and dry-needling for low back pain (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 130
(Continued) 30 October 2004 New citation required and conclusions have changed Substantive amendment 30 October 2004 New citation required and conclusions have changed The latest literature search was completed in June 2003 and the conclusions were updated in October 2004 In contrast to the previous review that concluded that the poor methodological quality of the trials did not allow any conclusions on the effectiveness of acupuncture, the current update demonstrated the effectiveness of meridian acupuncture for chronic low-back pain in some special cases: 1) compared to no treatment, acupuncture improved pain and function at short-term follow-up 2) compared to sham therapies, acupuncture improved pain at short-term follow-up, but these effects were not maintained at longer-term follow-up and they were not observed for functional outcomes 3) when acupuncture was added to other conventional therapies, there was better pain relief and improved function when compared to the conventional therapies alone. Also, this updated review examined acupuncture separately from dry-needling. The authors concluded that no clear recommendations could be made about dryneedling because of the small sample sizes and low methodological quality of the studies, although it appeared that dry-needling was a useful adjunct to other therapies for chronic low-back pain. Effects in all cases were only small 2 June 2003 New search has been performed The first version of this review included 11 randomized trials. This update added 24 more randomized trials, for a total of 35. Meta-analyses were performed for some comparison groups C O N T R I B U T I O N S O F A U T H O R S - Furlan, van Tulder, Cherkin, Lao, Koes and Berman wrote the protocol for this review; - Furlan, van Tulder, Koes conducted the literature search and study selection of the English language trials; - Tsukayama conducted the literature search and study selection of the Japanese language trials; - The Chinese Cochrane Centre conducted the literature search of the Chinese language trials and Lao selected the studies; - Furlan, van Tulder, Cherkin, and Koes performed the quality assessment and date extraction of the English language trials; - Lao and Tsukayama performed the quality assessment and data extraction of the Japanese and Chinese language trials; - All authors were involved in writing the final draft of the manuscript. Acupuncture and dry-needling for low back pain (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 131
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Acupuncture and dry-needling for lo
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Analysis 5.2. Comparison 5 acupunct
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[Intervention Review] Acupuncture a
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traditional meridian acupuncture po
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of experts in acupuncture treatment
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ack pain. The average improvement i
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Figure 2. Acupuncture compared to a
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245 patients who received acupunctu
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Although the conclusions showed som
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R E F E R E N C E S References to s
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Wu 1991 {published data only} Wu YC
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treatments by traditional acupunctu
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Araki 2001 (Continued) Conclusion:
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Ceccherelli 2002 Methods Participan
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Cherkin 2001 (Continued) or acupunc
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Ding 1998 Methods Participants Inte
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Garvey 1989 Methods Participants In
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Giles 1999 Methods Participants Int
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Giles 2003 Methods Participants Int
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Grant 1999 Methods Participants Int
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Gunn 1980 (Continued) varied) Costs
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Inoue 2000 (Continued) Notes Langua
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Kerr 2003 (Continued) For results,
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Kurosu 1979(b) Methods Participants
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Lehmann 1986 (Continued) Conclusion
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Li 1997 (Continued) Interventions O
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MacDonald 1983 (Continued) Language
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Meng 2003 (Continued) 12.7 Conclusi
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Sakai 1998 (Continued) 2) Oral medi
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Takeda 2001 (Continued) Mean age: 2
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Tsukayama 2002 Methods Participants
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Wang 1996 Methods Participants Inte
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Yeung 2003 Methods Participants Int
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(Continued) Kinoshita 1981 Koike 19
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GerAc (Continued) Interventions Out
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Munglani (Continued) Contact inform
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D A T A A N D A N A L Y S E S Compa
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3.1 Short-term follow-up (up to 3 m
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13.1 Immediately after the end of t
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3.2 Short-term follow-up (up to 3 m
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5 physical examination 1 Mean Diffe
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